Few EDs Screen Patients for Excessive Alcohol Use
Just one in six EPs consistently screened patients for excessive drinking, according to the results of a recently published investigation.1
“The problem of excessive alcohol use occurs frequently in ED patients. We wanted to find out what practicing emergency physicians were doing to identify patients with excessive drinking and help guide them toward treatment,” says David P. Sklar, MD, one of the study’s authors.
Sklar and colleagues used the American College of Emergency Physicians Emergency Medicine Practice Research Network to survey a national sample of 347 EPs. Of those surveyed, 16% reported “always/usually,” 70% reported “sometimes,” and 14% reported “never” screening adult ED patients for excessive alcohol use. Of the respondents who did screen patients, only 10.5% received an electronic health record reminder to do so.
“Previous surveys involved administrative personnel from the ED, who may not have been representative of practicing emergency physicians,” notes Sklar, a professor of medicine at Arizona State University.
Sklar and colleagues sought data on the barriers to interventions by EPs, who routinely care for patients hurt or killed by motor vehicle crashes or gun violence episodes where alcohol was a factor. “Many times, I have wondered if we might have been able to prevent these tragedies if we had recognized the problem drinking behaviors earlier,” Sklar laments.
Alcohol screening and brief interventions in the ED can be effective to guide patients into treatment.2 In their work, Sklar and colleagues wanted to find out where EDs were nationally in using this proven approach. Because of the relatively small percentage of EPs who never screened, “that made me think that we could work with those who admitted to sometimes screening, since at least they did not seem opposed to the idea,” Sklar says.
EPs reported limited time and lack of treatment options as barriers to screening more often. “We spend so much time documenting useless information in the medical record. Yet we have no time to have a conversation about a potentially lethal substance abuse problem,” Sklar observes. “It makes me very sad when a patient recognizes a problem with alcohol use, but we have no availability for treatment in the community at the time that the patient is ready to commit to it.”
It would be hard to argue that screening for excessive alcohol use constitutes the legal standard of care in emergency medicine, considering the inconsistent patterns reported among providers. “But I don’t think that gets us off the hook. Prevention should be as much a part of our practice as intervening during an acute illness or injury,” Sklar argues.
Community treatment systems are needed to facilitate the next steps after the ED screening. “The ED is where people often go during their most vulnerable times,” Sklar says. “We have an opportunity to help them prevent a future crisis if we can show them that help is available and how to access it.”
REFERENCES
- Uong S, Tomedi LE, Gloppen KM, et al. Screening for excessive alcohol consumption in emergency departments: A nationwide assessment of emergency department physicians. J Public Health Manag Pract 2022;28:E162-E169.
- D’Onofrio G, Degutis LC. Preventive care in the emergency department: Screening and brief intervention for alcohol problems in the emergency department: A systematic review. Acad Emerg Med 2002;9:627-638.
The ED is where patients often go during their most vulnerable times. Emergency providers can help vulnerable patients prevent a future crisis if they can show patients that help is available and how to access it.
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